AI-Powered Revenue Cycle Management for Claude Code

16 skills. 4 live APIs. The entire US healthcare revenue cycle in your terminal.

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The Problem

Healthcare billing in the US is a $4 trillion system running on arcane codes, shifting payer rules, and manual lookups across dozens of disconnected databases. A single coding error can mean thousands in lost revenue. A missed LCD update can trigger months of denials.

Skillfull brings the entire revenue cycle into your AI-powered terminal — with live data.

Try It Now

git clone https://github.com/DilawarShafiq/skillfull.git
cd skillfull

Then in Claude Code:

/rcm-copilot patient has diabetes with foot ulcer, need to code and check Medicare coverage

/claim-simulator coding-challenge +medicare

/icd10-lookup type 2 diabetes with peripheral angiopathy

/npi-verify 1234567893

/coverage-check continuous glucose monitoring

/denial-management CO-97 bundled arthroscopy codes

The Pipeline

Skillfull covers every phase of the revenue cycle, with live API validation at every step:

                          THE REVENUE CYCLE
  ┌──────────────────────────────────────────────────────────┐
  │                                                          │
  │   FRONT END              MID CYCLE             BACK END  │
  │                                                          │
  │  ┌──────────┐  ┌──────────┐  ┌──────────┐  ┌─────────┐ │
  │  │ Register │─▶│  Verify  │─▶│   Code   │─▶│ Capture │ │
  │  │ Patient  │  │ Benefits │  │ Services │  │ Charges │ │
  │  └──────────┘  └──────────┘  └──────────┘  └────┬────┘ │
  │   /patient-     /eligibility-  /medical-     /charge-   │
  │   registration   verification   coding       capture    │
  │                                                  │       │
  │              ┌───────────────────────────────────┘       │
  │              ▼                                           │
  │  ┌──────────┐  ┌──────────┐  ┌──────────┐  ┌─────────┐ │
  │  │  Submit  │─▶│  Post    │─▶│ Manage   │─▶│ Collect │ │
  │  │  Claim   │  │ Payment  │  │ Denials  │  │  A/R    │ │
  │  └──────────┘  └──────────┘  └──────────┘  └─────────┘ │
  │   /claim-       /payment-     /denial-      /ar-        │
  │   submission     posting       management    analysis   │
  │                                                          │
  └──────────────────────────────────────────────────────────┘

  Live Data Layer:
  ╔════════════╗ ╔════════════╗ ╔════════════╗ ╔════════════╗
  ║ ICD-10     ║ ║ NPPES      ║ ║ Medicare   ║ ║ CMS/CDC    ║
  ║ 2026 Codes ║ ║ NPI Lookup ║ ║ NCDs/LCDs  ║ ║ 50+ Sets   ║
  ╚════════════╝ ╚════════════╝ ╚════════════╝ ╚════════════╝

What's New: Innovation Skills

/rcm-copilot — The Revenue Cycle Brain

One command to rule them all. Describe any billing situation in plain English — the Copilot identifies what you need, queries the right APIs, and delivers a structured analysis.

/rcm-copilot claim denied CO-50 for adalimumab J0135, patient has Medicare

The Copilot will:

1. Decode the denial reason (CO-50 = non-covered service)
2. Check if adalimumab is on the Self-Administered Drug exclusion list
3. Search for relevant Medicare coverage policies (NCDs/LCDs)
4. Determine Part B vs Part D billing path
5. Recommend appeal strategy or alternative approach

No more guessing which tool to use. Just describe the problem.

/claim-simulator — Flight Simulator for Medical Billing

Interactive scenarios where you code real encounters, validated against live APIs. Every ICD-10 code you pick is checked in real time. Every claim decision has consequences.

/claim-simulator denial-gauntlet +medicare

┌─────────────────────────────────────────────┐
│             SIMULATION RESULTS              │
├─────────────────────────────────────────────┤
│                                             │
│  Coding Accuracy ........... ██████████ 95% │
│  Sequencing ................ █████████░ 90% │
│  Modifier Usage ............ ████████░░ 80% │
│  Claim Accuracy ............ ██████████ 100%│
│  Denial Resolution ......... █████████░ 90% │
│                                             │
│  REVENUE CAPTURED: $342.00 / $385.00        │
│  KEY TAKEAWAY: Modifier 25 was needed       │
│                                             │
└─────────────────────────────────────────────┘

Scenario types: beginner · coding-challenge · denial-gauntlet · coverage-maze · full-cycle · emergency

All 16 Skills

Orchestration

Command	What It Does
/rcm-copilot	Intelligent orchestrator — describe any billing situation, get multi-step guidance
/claim-simulator	Interactive billing simulator with live API validation and scoring

Interactive (Live API)

Command	Data Source	What It Does
/icd10-lookup	ICD-10 2026	Search, validate, and explore diagnosis/procedure codes
/npi-verify	NPPES Registry	Validate provider credentials, search by name/specialty
/coverage-check	Medicare NCDs/LCDs	Research coverage policies, check medical necessity
/claim-scrub	Multiple APIs	Pre-submission validation across code, coverage, and provider data

Front-End RCM

Command	What It Does
/patient-registration	Demographics, scheduling, pre-registration workflows
/eligibility-verification	Insurance verification, benefits, prior authorization

Mid-Cycle RCM

Command	What It Does
/medical-coding	ICD-10-CM/PCS, CPT, HCPCS coding with guidelines
/charge-capture	Service documentation, revenue integrity, charge reconciliation
/claim-submission	CMS-1500, UB-04, EDI 837 form guidance

Back-End RCM

Command	What It Does
/payment-posting	ERA/835 processing, EOB interpretation, CARC/RARC codes
/denial-management	Denial analysis, appeal templates, root cause investigation
/ar-analysis	A/R aging analysis, collection strategies, KPI calculations
/patient-collections	Statements, payment plans, financial assistance programs
/rcm-analytics	Revenue cycle KPIs, dashboards, payer benchmarking

Architecture

┌─────────────────────────────────────────────────────────┐
│                    CLAUDE CODE                          │
│                                                         │
│  ┌───────────────────────────────────────────────────┐  │
│  │               SKILLFULL SKILLS                    │  │
│  │                                                   │  │
│  │  ┌─────────────┐  ┌──────────────────────────┐   │  │
│  │  │ RCM Copilot │──│ Routes to 14 RCM Skills  │   │  │
│  │  └──────┬──────┘  └──────────────────────────┘   │  │
│  │         │                                         │  │
│  │  ┌──────┴──────┐                                  │  │
│  │  │  Simulator  │─── Generates & Validates         │  │
│  │  └──────┬──────┘    Scenarios                     │  │
│  │         │                                         │  │
│  └─────────┼─────────────────────────────────────────┘  │
│            │                                             │
│  ┌─────────┴─────────────────────────────────────────┐  │
│  │          MODEL CONTEXT PROTOCOL (MCP)             │  │
│  │                                                   │  │
│  │  ┌───────────┐ ┌──────────┐ ┌─────────┐ ┌─────┐  │  │
│  │  │ ICD-10    │ │ NPPES    │ │ CMS     │ │Mimi │  │  │
│  │  │ Codes     │ │ NPI      │ │Coverage │ │Labs │  │  │
│  │  │           │ │ Registry │ │ DB      │ │     │  │  │
│  │  │ Diagnoses │ │ Provider │ │ NCDs    │ │ 50+ │  │  │
│  │  │ Procedure │ │ Lookup   │ │ LCDs    │ │Data │  │  │
│  │  │ Validate  │ │ Search   │ │ SAD     │ │Sets │  │  │
│  │  └───────────┘ └──────────┘ └─────────┘ └─────┘  │  │
│  └───────────────────────────────────────────────────┘  │
│                                                         │
└─────────────────────────────────────────────────────────┘

Who This Is For

Role	How You'll Use It
Billing Specialists	Real-time code lookup, denial resolution, claim scrubbing
Revenue Cycle Managers	KPI dashboards, A/R analysis, payer benchmarking
Medical Coders	ICD-10/CPT guidance, coding challenges, certification prep
Practice Managers	Coverage verification, financial projections, compliance checks
Healthcare IT	MCP integration patterns, API workflows, automation templates
Students	Interactive simulator, scenario-based learning, exam prep

Certification Alignment

Skill content aligns with competencies tested on:

Certification	Organization	Skills Covered
CPC (Certified Professional Coder)	AAPC	medical-coding, icd10-lookup, claim-simulator
CCS (Certified Coding Specialist)	AHIMA	medical-coding, icd10-lookup, claim-simulator
CRCR (Certified Revenue Cycle Rep)	HFMA	All 16 skills
CPB (Certified Professional Biller)	AAPC	claim-submission, denial-management, payment-posting

Project Structure

skillfull/
├── .claude/
│   ├── settings.local.json          # MCP permissions
│   └── skills/                      # All 16 skills
│       ├── SKILLS.md                # Master index
│       ├── rcm-copilot/             # ★ Intelligent orchestrator
│       ├── claim-simulator/         # ★ Interactive simulator + scenarios
│       ├── icd10-lookup/            # ICD-10 code search (MCP)
│       ├── npi-verify/              # Provider verification (MCP)
│       ├── coverage-check/          # Medicare coverage (MCP)
│       ├── claim-scrub/             # Pre-submission validation (MCP)
│       ├── patient-registration/    # Demographics & scheduling
│       ├── eligibility-verification/# Insurance verification
│       ├── medical-coding/          # Coding guidance + reference
│       ├── charge-capture/          # Revenue integrity
│       ├── claim-submission/        # EDI 837, CMS-1500, UB-04
│       ├── payment-posting/         # ERA/835 processing
│       ├── denial-management/       # Appeals + templates
│       ├── ar-analysis/             # A/R management
│       ├── patient-collections/     # Patient responsibility
│       └── rcm-analytics/           # KPIs & reporting
├── .mcp.json                        # 4 MCP server connections
├── CONTRIBUTING.md                  # How to add skills
├── LICENSE                          # MIT
└── README.md                        # You are here

Contributing

We welcome contributions. See CONTRIBUTING.md for skill format requirements, healthcare accuracy guidelines, and MCP integration patterns.

Ideas for contributors:

• Specialty-specific skills (Cardiology, Oncology, Orthopedics)
• Payer-specific rule engines (UnitedHealth, Aetna, Cigna)
• Additional simulator scenarios
• International billing adaptations (CPT → OPCS, ICD-10-CM → ICD-10-AM)

Disclaimer

Educational and reference purposes only. Always verify against current CMS guidelines, payer policies, and applicable regulations. Not a substitute for official CMS documentation, professional coding certification, or legal/compliance advice.

License

MIT — Use it, fork it, build on it.

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